Cushings Disease in Dogs

[Missy216]

My Westie has been diagnosed with Cushings Disease.  She has a confirmed adrenal tumor, but our veterinarians are saying that all blood tests indicate that the Cushings is ptuitary dependent.  She has had an ACTH Stim, endogenous ACTH and LDDS.  Her symtoms include, increased thirst and urination, frequent bouts with urinary tract infections and some skin infections.
Abnormal lab values have included increased Alk Phos, increased cholesterol, increased blood sugar and mildly elevated WBCs
Her current course of treatment has been trilostane, starting out at a very low dose of 5mg/BID and closely checking her ACTH levels every 7 days (ACTH STIM TEST).  She did not show any improvement until her trilostane dose reached 35mg/BID at which time I am told the ACTH level came into high normal range and the decision was made to increase the dosage to 40mg/BID (maximum dose for her weight of 18 lbs).  After 5 days at this dose she developed, lethargy, anorexia, loose stools, vomiting.  Electrolyes were normal, pancreatic values increased and her WBCs showed marked elevation.  Trilostane was d/c'd temporarily and she is currently having another ACTH STIM done.
My question is:  Isn't it very unusual to have  an adrenal tumor and a pituitary tumor in the same dog?  She definitely has Cushings but can the blood tests misdiagnose the reason for the Cushings?  

[2012meme]

You seem very knowledgeable about cushings disease in dogs. Do you have experience with cats? My cat Tink is going on 2 years with cushings disease and diabetes. Cushing's is very rare in cats and I haven't been able to find anyone  who is living with a cat that has it. We are now having litter box issues on occasion. While her fur is missing from her belly, sides and hind legs, and her middle is large and round and the size of a volleyball (almost that is), and a growth on top of her head gets bigger, she is as loving as ever. She is always hungry and thirsty and has not lost weight. She gets 8 units of insulin twice a day using a Lantus Solarstar pen. Thanks for the opportunity to tell her story to someone who might understand.  

[Missy216]

I am so sorry to hear about your little dog.  It makes you feel so awful when they are sick and losing them is so heartbreaking.  We are hoping we caught this early enough, but so far treatment with trilostane has not been very effective.  She has been sick since Sunday and has been diagnosed with pancreatis, which apparently is a common problem in dogs with Cushings.  Currently she is in the hospital on IV fluids and IV antibiotics.  We are very fortunate to have a very good local vet and her condition does seem improved, but we always have the option of taking her to University of PA veterinary hospital. They are wonderful compassionate people there and have been life savers for some of our other animals.  Thank You for sharing your experience, it is helpful to know others care.

[Tennesseegirl]

I had a dog.. many years ago with a lump in her breast.. I got removed and was cancer.. later she got sick.. with all the symptoms you have mentioned..  she would get hot alot and I would put her in the tub to try and cool her off.. and thats when I noticed her hair was really thin.. almost bald.. she was a yourky so, I couldnt see it when her hair was dry. and it ended up with Cushings Disease I was too late with the results.
I just want to wish you the best for your little one. I hope they can stick with yours and give it some more time. I had very little time left with mine.at that point.. she just got really too sick. and it was cought to late. you are more then welcome to email me if you have any questions about her symptons and progress.. Its just sooo hard when they get sick like that. I wish her the best of care..

[lonewolf07]

Yes, it does help.  Thank you.

I hope you find a specialist who can help you and your Westie.

lonewolf

[Missy216]

Thank you for your interest.  Cushings disease is the overproduction of a steroid type substance by the adrenal gland. It can be caused by a tumor of the pituitary gland which is a gland in the brain which regulates the adrenal gland or it can be caused by a tumor in the adrenal gland itself.  Normal levels of this steroid type substance regulates a lot of different body functions but when the levels start to increase, it can cause many different problems.  The reverse of Cushings is called Addisons disease - it is the inability of the adrenal to produce enough steroid.  Hope this helps and thanks for your support.

[lonewolf07]

Hi

I'm somewhat embarrassed to ask this but what is Cushings Disease?  Feel like I "should" know but I don't.

Missy - I really do hope your little Westie is alright.  It sounds like you're taking such good care of her.

lonewolf (and a scratch on the head for the little Westie)

[Missy216]

Thank You for your feedback.  In answer to your question, she was initally diagnosed by our local veterinarian, but was evaluated at Ryan Veterinary Hospital in Philadelphia.  Her blood tests and medication are being managed by the local vet but with close consultation with the specialist.  I understand why they want her cortisol levels under control before they go forward with the surgery.  The tumor is small <1cm, but I am aware that 50% of these tumors can be malignant and I certainly hope they are on the right track with treatment so that there is not undo delay with her surgery.  From what I have read it is almost unheard of for an animal to have both an adrenal tumor and a pituitary tumor.  Thanks again for your feedback.

[ddeiman]

Did you have an internist diagnose this or a regular vet? If it's your reg vet I would ask to have copies of everything and have an internist review it all for a 2nd opinion or if you can't afford that have your vet consult with an internist about treatment. I would think that the tumor needs to be removed regardless and still continue the trilostane. It does take a while to get the right dose and the right dose will change over time so monitoring with ACTH stims is good but the levels may get thrown off by the tumor causing symptoms. Definitely an odd case and worth a 2nd set of eyes by a specialist.